Alcohol
Use Among Adolescents and Young Adults

Michael
Windle, Ph.D.

Michael
Windle, Ph.D., is a professor of psychology and director of the Center
for the Advancement of Youth Health, University of Alabama at Birmingham.

This research
was supported by grant R37–AA–07861 from the National Institute
on Alcohol Abuse and Alcoholism.

National surveys
of adolescents, college students, and other young adults in the United States
reveal high rates of alcohol use among these age groups as well as high rates
of dangerous drinking practices such as binge drinking and daily drinking. Additional
health–compromising behaviors such as tobacco use and drinking and driving
often co–occur with alcohol use in these populations. The physical locations
or drinking contexts where alcohol use occurs can predict drinking practices
and consequences. This information can be used to identify appropriate targets
for effective interventions and social policies.Key
words: adolescent; young adult; high school student; undergraduate student;
high–risk youth; AOD (alcohol and other drug) use; prevalence; epidemiological
indicators; AOD associated consequences; risk–taking behavior; gender
differences; United States

Alcohol use during adolescence
and young adulthood remains a prominent public health problem in the United
States. National survey results indicate that 28.6 percent of 12th graders and
40.1 percent of college students reported binge drinking (i.e., consuming five
or more drinks in a row) during the 2–week period preceding the survey
(Johnston et al. 2003a,b). Alcohol use among adolescents and college
students is also associated with a broad array of risk behaviors, including
tobacco use and drinking and driving. In addition, studies on college campuses
have shown that students who do not drink nevertheless experience adverse secondhand
effects of drinking, including victimization (e.g., verbal or physical threats
and actions) and personal intrusion (e.g., disruption of sleep or study habits)
by those who have been drinking (Wechsler et al. 1998). Another disturbing trend
in youth drinking is the initiation of alcohol use at younger ages. Between
1987 and 1996, surveys have shown that the average age of initiation to alcohol
use decreased by more than 1.5 years, from 17.8 years in 1987 to 15.9 years
in 1996 (Office of National Drug Control Policy 1997). In 1999, more than 32
percent of young people reported beginning to drink before age 13 (Centers for
Disease Control and Prevention [CDC] 2000). Earlier initiation of alcohol use
(prior to age 15) has been associated with increased risk for alcohol–related
problems later in life (Grant and Dawson 1997).

This article reviews epidemiological
data on alcohol use among adolescents, college students, and young adults not
in college, and presents data on the physical locations or drinking contexts
where alcohol use occurs. In addition, this article discusses the prevalence
of health–compromising behaviors that often co–occur with youth
drinking, such as smoking, illicit drug use, and risky sexual behaviors.

PREVALENCE OF ADOLESCENT
ALCOHOL USE

Findings from the Monitoring
the Future Survey (MFS) (Johnston et al. 2003a)—for which a nationally
representative sample of 8th, 10th, and 12th graders are surveyed each year
on alcohol and other drug use—indicate a very high rate of alcohol use
in this population. Table 1 presents data on two common indicators of adolescent
alcohol use, the percentage of respondents who report having consumed alcohol
in the 30 days before the survey (30–day prevalence) and the percentage
of those who report having been drunk within the previous 30 days. There are
clear trends toward higher prevalence of both 30–day use and having been
drunk in the last 30 days among those in higher grades; it is significant that
19.6 percent of 8th graders reported using alcohol in the previous 30 days,
and 6.7 percent reported having been drunk during that time. All of these students
are legally underage drinkers. Furthermore, the high prevalence of drinking
at an early age bodes ill for psychosocial development among youth because of
the increased risk for both alcohol–related problems (e.g., poorer school
performance, more substance–using peers) and other co–occurring
problems (e.g., delinquency, sexual activity) (Windle 1999). Consistent with
national surveys conducted in previous years, geographically the Northeast and
North Central regions had the highest prevalence of alcohol use by young people,
followed by the West and South. There were few differences between metropolitan
and nonmetropolitan areas. Among racial and ethnic groups, White youth generally
had the highest prevalence of alcohol use, followed by Hispanics. African Americans
had significantly lower levels of alcohol use compared with Whites or Hispanics
across all grade levels (Johnston et al. 2003a).

Gender Comparisons

Researchers have suggested
that the differences in alcohol use between males and females are converging
(White and Huselid 1997), but it appears that there is more convergence on some
alcohol indicators than others. The data in table 1 indicate that male and female
8th and 10th graders had similar rates of both using alcohol and having been
drunk in the previous 30 days. Nonetheless, gender differences emerge among
12th graders, with males having a higher 30–day prevalence of alcohol
use and of having been drunk.

Table 1. Prevalence
of Having Used Alcohol, and Having Been Drunk in the 30 Days Preceding the Survey,
Among Various Demographic Subgroups of 8th, 10th, and 12th Graders in 2002

Table 2 presents data for
males and females on additional indicators of alcohol use. These findings indicate
an approximately equal prevalence of lifetime alcohol use for boys and girls
at each grade level. By the 12th grade, however, marked gender differences emerge
in binge drinking in the previous 2 weeks and in daily use of alcohol (defined
as drinking alcohol on 20 or more occasions in the past 30 days). Hence, although
alcohol use and dangerous drinking practices (e.g., getting drunk, binge drinking)
occur among both boys and girls, these practices are more prevalent among boys
by the 12th grade.

Table 2. Prevalence
of Ever Having Used Alcohol, Having Five or More Drinks in a Row in the 2 Weeks
Preceding the Survey, and Daily Drinking* Among Gender Groups in 2002

Ever
Used Alcohol (%)

5+
Drinks in a Row in Last 2 Weeks (%)

Daily
Use of Alcohol*

Grade

8th

10th

12th

8th

10th

12th

8th

10th

12th

Males

47.2

65.5

77.9

12.5

23.8

34.2

0.8

2.6

5.3

Females

46.8

68.5

78.5

12.1

21.0

23.0

0.4

1.0

1.7

*Daily use was defined
as drinking alcohol on 20 or more occasions in the past 30 days.

SOURCE: Johnston et al.
2003a.

Adolescents in Alternative
Schools

Children attending alternative
high schools constitute a distinctive subpopulation of adolescents who may be
at increased risk for the development of serious alcohol problems. Alternative
high schools serve students at risk for failing or dropping out of regular school
and students who have been removed from their regular high schools because of
behavior problems such as violence or substance use. About 2 percent (280,000)
of all high school students attend alternative schools (Quality Education Data,
Inc. 1997). Grunbaum and colleagues (2000) reported that in 12th grade, 73.5
percent of boys and 60.1 percent of girls selected from a nationally representative
sample of alternative schools reported consuming alcohol in the previous 30
days, and 55.4 percent of boys and 42.9 percent of girls reported consuming
five or more drinks in a row during the previous 30 days. These rates of alcohol
use were considerably higher than those for youth from regular high schools,
as were the rates of a range of other health–compromising behaviors such
as drinking and driving, suicide attempts, unintended pregnancies, and sexually
transmitted diseases. Although these rates of alcohol use and co–occurring
problems among adolescents in alternative schools are high, these schools have
typically not been the focus of targeted interventions.

PREVALENCE OF COLLEGE STUDENT
AND YOUNG ADULT ALCOHOL USE

Rates of drinking among
college students and other young adults are also high. College students are
often undergoing role transitions—such as moving away from the family
home for the first time, residing with other students, and experiencing reduced
adult supervision—that may increase the risk of alcohol use and abuse.
College students also frequently reside in different physical and social environments
and encounter new social and institutional factors (e.g., college parties, football
weekends) that may foster heavy alcohol use.

Table 3 presents findings
from the MFS followup surveys among college students and other (noncollege)
young adults (Johnston et al. 2003b). These are referred to as followup
surveys because the young adult samples (both college and noncollege) were selected
from high school students who had previously participated in the MFS during
their senior year in high school. The college student sample consisted of full–time
students, 1 to 4 years post–high school (ages 18 to 23), enrolled in a
2– or 4–year college. The noncollege sample consisted of adults
ages 19 to 28 who were not full–time students. The findings indicate very
high rates of alcohol use and binge drinking as well as a fairly large number
of daily drinkers among both college and noncollege young adults. College females,
relative to noncollege females, had a higher prevalence of using alcohol in
the previous 30 days and a higher rate of binge drinking. College males had
higher rates of binge drinking, alcohol use in the previous 30 days, and daily
alcohol use than did noncollege males. Gender comparisons within the college
and noncollege samples indicated a pattern similar to that observed in secondary
students: Compared with females, males reported higher rates of more serious
manifestations of alcohol use (i.e., significantly higher prevalences of binge
and daily drinking).

Table 3. Prevalence
of Alcohol Use in the 30 Days Preceding the Survey, Having Five or More Drinks
in a Row in the 2 Weeks Preceding the Survey, and Daily Drinking* Among College
Students and Other Young Adults in 2000

Used
Alcohol in Previous 30 days (%)

5+
Drinks in a Row in Previous 2 Weeks (%)

Daily
Use of Alcohol (%)

College
Status

College

Noncollege

College

Noncollege

College

Noncollege

Males

70.2

65.5

50.7

43.8

7.0

5.3

Females

68.0

56.1

33.4

29.0

3.7

3.5

Total

68.9

60.1

40.1

35.4

5.0

4.3

*Daily use was defined
as drinking alcohol on 20 or more occasions in the past 30 days.

NOTE: The table reflects
findings from the Monitoring the Future followup surveys of college students
and other (noncollege) young adults who had previously participated in the
survey during their senior year in high school. The college student sample
consisted of full–time students, 1 to 4 years post–high school,
enrolled in a 2– or 4–year college. The noncollege sample consisted
of adults ages 19 to 28 who were not full–time students.
SOURCE: Johnston et al. 2003a,b.

As noted previously, the
MFS followup (Johnston et al. 2003b) is limited to high school graduates.
To supplement these data, findings for full–time college students and
other young adults from the 2000 National Household Survey on Drug Abuse (NHSDA)
(Substance Abuse and Mental Health Services Administration 2001) are provided
in table 4. The NHSDA is not restricted to high school graduates and therefore
provides a more representative sample of young adults. The findings in table
4 indicate patterns similar to those reported for the MFS; college students,
compared with noncollege young adults, have higher rates of previous 30–day
alcohol use and binge drinking. These somewhat larger differences for the NHSDA
sample than the MFS sample may be attributable to differences in the samples
(i.e., the MFS sample consisted of high school graduates only). The measures
of serious drinking used in the two surveys are not parallel, but the findings
are similar. The NHSDA measured heavy episodic drinking, defined as having five
or more drinks on the same occasion at least 5 days in the past 30 days, and
found that heavy episodic drinking was higher among full–time college
students. The MFS measured daily use of alcohol, and the prevalence was higher
among college than noncollege young adults. Hence, both surveys indicated more
serious drinking among college students compared with noncollege young adults.

Table 4. Prevalence
of Alcohol Use in the 30 Days Preceding the Survey, Having Five or More Drinks
in a Row in the Past Month, and Heavy Episodic Drinking* in the Past Month,
by College Students and Noncollege Young Adults Ages 18 to 22 in 2000

30–Day
Prevalence of Alcohol Use (%)

5+
Drinks in a Row, Last 30 Days (%)

Heavy
Episodic Drinking (%)*

Full–Time
College Students

62.0

41.4

16.4

Other
Young Adults

50.8

35.9

12.1

*Heavy episodic drinking
was defined as having five or more drinks on the same occasion at least 5
days in the past 30 days.

Another study of college
drinking, the 1995 National College Health Risk Behavior Survey (CDC 1997),
investigated the prevalence of alcohol use and other risk behaviors among a
national sample of 4,609 college students from 136 institutions. These findings,
summarized in table 5, show gender differences similar to those reported in
the other surveys: Males had higher prevalences than females of alcohol use
during the previous 30 days, binge drinking during the previous 30 days, and
daily drinking. Observed differences in alcohol use across racial/ethnic groups
were also similar. African Americans reported the lowest prevalence of alcohol
use and Whites the highest prevalence. The younger age group (18 to 24 years)
had higher prevalences of drinking during the previous 30 days and binge drinking
than did people 25 years and older. These age group differences may indicate
that some older students are “maturing out” of heavier alcohol use
or adopting adult social roles (e.g., spouse, parent) that are associated with
decreased alcohol use (e.g., Miller–Tutzauer et al. 1991). However, it
should be noted that the prevalence of daily drinking was higher among older
respondents, which could reflect progression into dependent drinking by a portion
of this population.

Table 5. Prevalence
of Alcohol Use in the 30 Days Preceding the Survey, Having Five or More Drinks
in a Row in the Preceding 30 Days, and Daily Drinking* Among College Students,
by Gender, in 1995

30–Day
Prevalence of Alcohol Use (%)

5+
Drinks in a Row Last 30 Days (%)

Daily
Drinking (%)*

Female

Male

Female

Male

Female

Male

Age
Group

18–24
years

67.0

73.2

34.8

48.7

1.6

5.4

25 years
and older

60.8

71.8

15.7

32.2

3.1

9.2

Race/Ethnicity

African
American

49.0

62.6

6.1

22.8

1.1

2.4

White

69.7

75.7

31.6

49.4

2.5

7.6

Hispanic

58.0

71.2

22.6

39.9

1.1

3.0

Institution
Type

2–year

59.4

67.9

20.6

34.8

2.5

6.6

4–year

69.0

76.6

32.8

50.7

1.9

6.6

Total

64.5

72.9

27.0

43.8

2.2

6.6

*Daily drinking was defined
as drinking alcohol on 20 or more days in the 30 days preceding the survey.

SOURCE: Centers for Disease
Control and Prevention 1997.

Both the prevalence of alcohol
use during the last 30 days and the prevalence of binge drinking were higher
among students at 4–year institutions than among students at 2–year
institutions. The prevalence of daily drinking was slightly higher for women
at 2–year institutions, compared with those at 4–year institutions,
and was the same for men at the two types of institutions. Living conditions
(e.g., dormitory rather than family home) and the increased role of fraternities
and sororities on 4–year campuses compared with 2–year campuses
may be important factors influencing the differences in rates of binge drinking
and 30–day alcohol use at the two types of institutions.

As reviewed above, survey
data provide a consistent picture of high rates of alcohol use, binge drinking,
and daily drinking on college campuses. Another important index of alcohol use
by college students is the extent of alcohol–related adverse consequences.
Table 6 summarizes data on alcohol–related adverse consequences among
college students, based on a nationwide survey of 54,444 undergraduates at 131
college campuses (Core Institute, Southern Illinois University 2001). These
findings indicate that many students experience adverse consequences from drinking;
64.5 percent reported having had a hangover, 29.0 percent reported driving a
car while under the influence, and 31.8 percent reported arguing or fighting.
These high rates of adverse consequences are consistent with the high rates
of alcohol use reported in the surveys cited above, and they do not portend
well for the health and well–being of many college students. The influence
of drinking context, such as place of residence for college students, is described
below, along with findings on the secondhand consequences of college drinking.

Table 6. Annual
Prevalence of Adverse Consequences Associated With Alcohol Use Among College
Students in 2001

Adverse Consequences

Percentage

Had
a hangover

64.5

Got
nauseated or vomited

55.5

Did
something they later regretted

40.5

Missed
a class

34.1

Drove
a car while under the influence

29.0

Got
into an argument or fight

31.8

Were
criticized by someone they know

32.3

Performed
poorly on a test/other project

24.4

Had
trouble with police or other authorities

16.5

SOURCE: Core Institute
2001.

DRINKING CONTEXTS

Standard surveys about the
prevalence of alcohol use generally do not gather information about key situational
or contextual conditions, such as the location of drinking. This information,
however, may have a significant bearing on the interpretation of survey findings
and on the identification of appropriate targets for effective interventions
and social policies.

Adolescents consume alcohol
in a variety of contexts, including their own homes, homes of friends or acquaintances,
bars or restaurants, outdoor settings (e.g., parks, beaches, sports stadiums),
at school or work, and in moving cars or trucks. Based on a sample of 1,914
high school seniors, Lee and colleagues (1997) reported that the three most
highly endorsed locations for drinking were in another person’s home,
an outdoor setting, and a moving car or truck. Drinking outdoors and drinking
in a car or truck were both significant predictors of alcohol–impaired
driving (i.e., self–reported driving after drinking enough to affect driving),
even when statistically controlling for several other predictor variables such
as gender, discretionary income, number of drinking occasions in the last 30
days, and number of binge drinking episodes in the last 2 weeks. Drinking in
a car or truck (including drinking by drivers) was associated with a 2.5 times
higher probability of driving while impaired, and drinking outdoors was associated
with a 1.5 times greater probability.

Several studies have indicated
that living circumstances are a major contextual influence on college student
drinking behaviors (Perkins 2002). For example, using data from the 1993 College
Alcohol Study of 17,592 students from 140 campuses in 40 States and the District
of Columbia, Wechsler and colleagues (1995) reported that fraternity residence
(relative to nonfraternity residence) was associated with an almost sevenfold
increase in the probability of bingeing or of episodic drinking. After statistically
controlling for several other variables that might influence binge drinking
in college—such as binge drinking in high school, school grades, cigarette
use, and importance of religion—fraternity residence was still associated
with a fourfold increase in the probability of binge drinking. Similar findings
have been reported in other studies (Presley et al. 2002), though the presence
of a Greek system does not necessarily correlate with a high percentage of binge
drinkers among a college’s students. Fraternity residence could account
for at least some of the college versus noncollege differences in episodic heavy
drinking reported above. Similarly, with a representative sample of almost 2,000
New York State college students (ages 18 to 25 years), Barnes and colleagues
(1992) reported that living in a dormitory instead of living at home with parents
was associated with substantially higher levels of alcohol use and alcohol–related
adverse consequences.

In another study of drinking
contexts, Wechsler and colleagues (1998) used data from a 1997 College Alcohol
Study that surveyed 14,521 students from 130 colleges. The researchers first
categorized college campuses as low, medium, or high with respect to the prevalence
of binge drinking among students. Binge drinking was defined as low on campuses
if it was reported by less than 36 percent of students; medium, if reported
by 36 to 50 percent of students; or high, if reported by more than 50 percent
of students. The researchers then assessed the association between the level
of binge drinking on campus and adverse secondhand effects caused by students
who were drinking but experienced by students who were nonbingeing drinkers
or abstainers. Secondhand effects included events such as having been insulted
or humiliated; having been pushed, hit, or assaulted; having experienced an
unwanted sexual advance; having had studying or sleep interrupted; and having
had to take care of a drunken student. The findings indicated that significantly
higher levels of adverse secondary effects occurred on campuses with higher
levels of binge drinking. For example, 74 percent of nonbinge and abstaining
students reported having had their studying or sleep interrupted on high binge–drinking
campuses, compared with only 40 percent on low binge–drinking campuses.
Similarly, 20 percent of students reported property damage on the high binge–drinking
campuses, compared with only 6 percent on low binge–drinking campuses.
Hence, binge drinking varies across campuses and can have negative effects for
both the binge drinkers and nonbinge–drinking and abstaining students.

ALCOHOL AND CO–OCCURRING
HEALTH RISK BEHAVIORS

Alcohol use among adolescents
co–occurs with a range of other risky behaviors including tobacco use,
sexual activity, violence, drinking and driving, and suicide (Windle 1999).
Based on data collected from more than 4,000 adolescents (ages 13 to 18 years)
in the 1995 NHSDA, Johnson and colleagues (2000) reported strong relationships
between binge drinking and smoking. For example, adolescents who reported binge
drinking in the 30 days before the survey were 17 times more likely to have
smoked during that time than adolescents who did not report binge drinking.
Also, among adolescents who did not binge drink in the previous 30 days, more
than 82 percent did not smoke during that time. These findings indicate that
alcohol use (in this instance, specifically binge drinking) and smoking are
highly associated with each other.

Findings from the National
College Health Risk Behavior Survey (CDC 1997) have also demonstrated significant
associations between alcohol use and co–occurring risky behaviors among
college students. For example, during the 30 days preceding the survey, 27.4
percent of college students nationwide reported driving a vehicle after consuming
alcohol. Males were more likely to report driving after drinking than females
(33.2 percent compared with 22.8 percent), and Whites (31.2 percent) and Hispanics
(24.8 percent) were more likely than African Americans (14.7 percent) to report
driving after drinking. Similarly, of the 76.8 percent of college students who
had gone boating during the 12 months preceding the survey, 30.5 percent had
consumed alcohol when boating or swimming. During the 30 days preceding the
survey, 35.1 percent had ridden in a car with a driver who had been drinking
alcohol. Among sexually active college students, 16.6 percent used alcohol or
other drugs during their last sexual intercourse, and this rate was higher among
younger students (19.3 percent among those ages 18 to 24) compared with older
students (13.1 percent among those ages 25 years or older).

SUMMARY

Epidemiological findings
on adolescent and young adult alcohol use reveal several disturbing trends.
National data indicate not only that there are high rates of alcohol use among
these age groups, but also that many adolescents and young adults engage in
drinking practices (e.g., binge drinking, daily drinking) associated with major
contributors to youth mortality (e.g., automobile crashes, suicide) and with
disruptions in significant contexts (e.g., school, work, family) that are important
for healthy development. The findings also indicate that there are important
secondary effects (e.g., having been pushed, hit, or assaulted; having study
habits or sleep disturbed) for abstainers and nonbinge drinkers on college campuses
with high rates of binge drinking. The findings regarding gender differences
indicate that almost as many females as males are consuming alcohol, but that
males in adolescent, college, and noncollege samples have a higher prevalence
than females of more serious drinking patterns such as binge drinking and daily
drinking. Racial/ethnic group differences indicate the highest prevalence of
use among Whites, with Hispanics second, and African Americans at substantially
lower levels. These racial/ethnic group findings were consistent across the
multiple probability samples referred to in this article.

In addition to the high
rates of alcohol use among these youthful populations, survey data demonstrate
the common co–occurrence of additional health–compromising behaviors
(e.g., tobacco use, illicit drug use, risky sexual behavior) among heavier users.
This information should be integrated in subsequent intervention efforts and
social policies regarding the health and well–being of youth (Hingson
and Howland 2002; Shulenberg and Maggs 2002). These findings also support concerted
efforts to address the numerous problems associated with alcohol use among adolescents
and young adults. In addition, the information provided in this article clearly
suggests that there are distinct drinking subcultures on many college campuses
that foster negative consequences for both drinkers and those around them. Interventions
and social policies on college campuses must incorporate this information to
effectively modify alcohol use and its adverse primary and secondary consequences
on college campuses.

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